Skin cancer is the most common cancer worldwide and one of the most preventable. Skin cancer incidence continues to rise among adolescents. The inconsistent practice guidelines for skin cancer prevention create challenges for counseling. The purposes of this study were to investigate skin cancer knowledge, attitudes, and primary prevention counseling practices by Arizona nurse practitioners caring for adolescents on an outpatient basis and to determine congruency of counseling with evidence-based guidelines. Participants completed a quantitative, descriptive, cross-sectional study using an online survey. The main variables were knowledge of skin cancer, skin cancer prevention, attitudes regarding counseling, current practice guideline use, and recommendations. Of the 67 participants who responded to the survey, 51 were eligible, and 44 completed the survey. Participant knowledge regarding skin cancer was moderate to low, and less was known about skin cancer in adolescents. Despite positive attitudes toward skin cancer prevention, participants reported low rates of counseling in practice, similar to previous interdisciplinary research. Reported recommendations used in practice were not reflective of any one particular guideline. Future research should explore barriers to incorporating primary prevention counseling practices and aim to educate nurse practitioners on skin cancer prevention.